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Foot checks, education reduce amputations in diabetic patien

Diabetes can lead to neuropathy, or lack of feeling, and wounds that are difficult to heal in patients’ feet. In years past, all too often that meant amputation of part or all of the foot. But now thanks to regular foot checks and an aggressive patient education program, diabetic Veterans at the Ralph H. Johnson VA Medical Center have significantly lowered rates of necessary amputation.

In 2000, the amputation rate across VA for diabetic patients was 10.2 percent. In 2013 that rate is down to 2.1 percent nationally, and just 1.6 percent at Charleston VAMC. Physical Therapist Mark Golub, who tracks the rates and works to rehab Veterans facing amputation attributes the dramatic decrease to foot checks that are conducted each time a diabetic patient is seen and education that involves Veterans in self-care.

“A lot of negatives add up,” said Golub. “If a patient is not taking his medications, not getting good nutrients, not doing what the doctor says, they’re not going to have good outcomes.” Golub and Diabetic Educator Cheryl Pratt, RN have made it their mission to change that possibility.
Pratt teaches group and individual classes for pre-diabetics (those with an elevated blood sugar but not a diagnosis of diabetes yet), patients who are newly diagnosed and diabetic patients who need a refresher to improve their health. She teaches seven goals: healthy eating, physical activity, reducing risk, stress and coping, taking medications, problem solving and weight management to help Veterans manage their disease. Pratt, who is part of the VAMC’s four-person diabetes education team, is a member of the group that is the only nationally certified program accredited by the American Diabetes Association in the VA Southeast Network.

“Most amputations are the result of an infection that won’t heal,” Pratt explained. Diabetic patients often experience loss of good circulation which is critical for healing. Pratt stresses the importance of exercise to patients as it can increase blood flow to the feet.
Golub stresses appropriate footwear and wearing diabetic socks.

“Most people don’t realize they’re wearing the wrong size shoe,” Golub said. Appropriate footwear should have good arch support, proper width and length and a square or box toe to avoid putting pressure on the foot. Diabetic socks have no seams for the same reason.
One in every four Americans is diabetic, and South Carolina has the seventh highest rate for diabetes in the country.

“It’s an epidemic,” said Pratt. “Diabetes may lead to complications and even death, but it is truly a disease that can be managed.”
The reduced amputation rate for Charleston VAMC patients is proof of that, according to Golub, and regular foot checks, patient education and diabetes management are the keys that make it possible.